Anatomic Basis of Neurologic Diagnosis

783 Pages·2009·44.4 MB·English

by  Cary D. Alberstone

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Library of Congress Cataloging-in-Publication Data
Anatomic basis of neurologic diagnosis / Cary D. Alberstone … [et al.].
p.; cm.
Includes bibliographical references and index.
ISBN 978-0-86577976-1 (alk. paper)
1. Neurologic examination. 2. Neuroanatomy. I. Alberstone, Cary D.
[DNLM: 1. Diagnostic Techniques, Neurological. 2. Central Nervous System
—anatomy & histology. WL 141 A535 2009]
RC348.A53 2009
616.8′0475—dc22
2008035366
Copyright © 2009 by Thieme Medical Publishers, Inc. This book, including all
parts thereof, is legally protected by copyright. Any use, exploitation, or
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clinical experience broaden our knowledge, changes in treatment and drug
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involved in the preparation of this work, warrants that the information contained
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Some of the product names, patents, and registered designs referred to in this
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Printed in China
5 4 3 2 1
ISBN 978-0-86577976-1
To my wife, Lisa: Thank you for your patience and your friendship.
And to my children, Lauren and Adam: The nervous system is an extraordinary
asset; use yours to the utmost.
— Cary Alberstone
I dedicate this book to Mrs. Benzel (Mary, my wife) for her unending love and
support of my craziness and to our children (Morgan, Jason, Brian, and
Matthew) for their tolerance and their commitment to the team we call family.
— Ed Benzel
To my wife, Tania, whose continuous support allowed me to work on this book,
and to my children, Elias, Joseph and Maya, who make our efforts all
worthwhile.
— Imad Najm
I dedicate this book to my wife, Bettina, and my children, Cameron and Marcus,
for their unending love and support. My family continuously reminds me why
we undertake such endeavors.
— Michael Steinmetz
Contents
Foreword
Preface
Section I Development and Developmental Disorders
1 Neuroembryology
Section II Regional Anatomy and Related Syndromes
2 Peripheral Nerves
3 Plexuses
4 Nerve Roots and Spinal Nerves
5 Spinal Cord
6 Brainstem
7 Cranial Nerves
8 Cerebellum
9 Thalamus
10 Hypothalamus
11 Basal Ganglia
12 Limbic System
13 Cerebral Cortex
Section III System-Based Anatomy and Differential Diagnosis
14 Somatosensory System
15 Visual System
16 Auditory System
17 Vestibular System
18 Ocular Motor System
19 Motor System
20 Autonomic Nervous System
21 Consciousness
Section IV Fluid-System Anatomy and Function
22 Vascular System
23 Cerebrospinal Fluid
Index
Foreword
The authors of this volume are a world-class group of clinical neuroscientists
from one of the world's greatest medical centers. They have done a masterful job
of integrating basic anatomy and neurologic diagnosis based on the patient's
signs and symptoms. This is the best book I have seen on the correlation
between neuroanatomy and clinical findings during my more than 40 years of
clinical practice. In 23 chapters, beginning with neuroembryology and ending
with cerebrospinal fluid, they have covered the full spectrum of regional and
system-based neuroanatomy, related syndromes, and differential diagnosis. The
presentation of each topic is concise, but it is comprehensive in its overall
coverage of neurologic diagnosis. The text in each chapter is supplemented with
color illustrations showing the anatomic basis of the patient's signs and
symptoms. Students and trainees will benefit from studying this book from cover
to cover, and clinicians with advanced knowledge and experience will use it
frequently for quick reference.
Albert L. Rhoton Jr., MD
R.D. Keene Family Professor
Professor and Chairman Emeritus
Department of Neurosurgery
University of Florida
Preface
This book is intended for medical students, residents, and practicing clinicians
who wish to understand or review the basic anatomic concepts that underlie
neurologic diagnosis. The book explains the fundamentals of neuroanatomy and
illustrates their clinical application. In keeping with this philosophy, this book
emphasizes principles and clinically relevant facts: anatomic details with little or
no clinical import are discussed briefly or omitted so as to concentrate on the
essentials of neurologic diagnosis.
This fund of knowledge is organized as the clinical neurologist would organize
it: by regions and functional systems. Thus, after an introductory chapter on
neuroembryology (Part I), Part II of the book comprises a series of chapters on
the anatomy of regional parts of the nervous system, including peripheral nerves,
plexuses, nerve roots and spinal nerves, spinal cord, brainstem, cranial nerves,
cerebellum, thalamus, hypothalamus, basal ganglia, limbic system, and cerebral
cortex. These chapters are divided into two sections: the first section describes
the basic anatomy of the region, the second section discusses the region's
cardinal manifestations in disease.
Part III comprises a series of chapters on functional systems. These include the
somatosensory system, visual system, auditory system, vestibular system, ocular
motor system, motor system, autonomic system, and consciousness. These
chapters are divided into two sections: the first section describes the basic
anatomy of the system, the second section describes a practical approach to the
patient with a system disorder. Part IV comprises a chapter on the vascular
system and a chapter on the cerebrospinal fluid.
To complement and amplify the text we have illustrated the book lavishly with
original drawings that convey anatomic and clinical concepts. These unique
drawings are rendered so as to illustrate structure, function, and dysfunction in a
single view. Thus each drawing illustrates the clinical deficit associated with a
described structure, or, conversely, a structure that produces a described clinical
deficit.
In introducing clinical material we have eschewed the fashionable "clinical
notes" and "clinical correlates" frequently found in neuroanatomy textbooks. The
inclusion of such corollaries, which primarily comprise descriptions of randomly
selected syndromes, diseases, and diagnostic tests, in our view fails to meet the